孕晚期脂联素与妊娠期糖代谢异常产后转归的关系

Relationship between Third Trimester Adiponectin and Postpartum Glucose Metabolism in Gestational Abnormal Glucose Tolerance Patients

【目的】探讨孕晚期血清脂联素水平与产后糖代谢转归的关系,为产后糖代谢持续异常患者的早期预测和干预提供依据。【方法】对我院规律产检并住院分娩的68名妊娠期糖代谢异常患者进行前瞻性研究,分析孕晚期脂联素水平及其它孕期指标与产后糖代谢的关系。【结果】39名妊娠期糖代谢异常患者于产后6～8周复诊时行75 g OGTT试验,持续存在糖代谢异常者为11名,其中空腹血糖受损(IFG)1例,糖耐量受损(IGT)10例。产后IGT者和产后糖耐量正常者(NGT)相比,IGT的产妇孕晚期空腹血糖和妊娠晚期脂联素水平低于NGT的产妇。校正基础BMI后,妊娠晚期脂联素水平与产后OGTT 1 h、2 h血糖呈负相关(P<0.05)。妊娠晚期脂联素的ROC曲线显示,以NGT为阳性时,曲线下面积Az=0.746,95%IC为(0.566,0.927),表明孕晚期脂联素对产后NGT有预测价值。取脂联素=7.035μg/mL为诊断临界点,计算得相对危险率OR为2.586。【结论】产后糖代谢恢复正常者妊娠晚期脂联素水平比产后糖代谢持续异常者高,孕晚期脂联素>7.035μg/mL者产后短期内恢复正常的几率约是<7.035μg/mL者的2.6倍。

[ Objective] To seek a predictor for the prognosis of gestational abnormal glucose tolerance patients. [ Methods] The study prospectively follow-up 68 gestational abnormal glucose tolerance patients in the first affiliated hospital of Sun Yat-sen University from September to November 2007. [Result] Thirty-nine patients come back for postpartum oral glucose tolerance test （OGTT）. The total amount of patients with persistent abnormal glucose tolerance was 11, among which 1 case was impaired fasting glucose （IFG） and the other 10 were impaired glucose tolerance （IGT）. The third trimester plasma adiponectin concentration was significant lower in the women who were identified IGT in the follow-up than those become normal. The third trimester adiponectin was significantly negative related to postpartum OGTY 1 h and 2 h blood glucose. Through Stepwise Regression analysis, only third trimester adiponectin was the risk factor of postpartum OGTT 2 h blood glucose. Setting normal glucose tolerance as positive, the area under the receiver operating characteristic （ROC） curve of third trimester adiponectin was 0.746, 95% confidence interval was （0.566,0.927）. Selecting adiponectin = 7.035 ug/mL as the cut-off point, the relative risk （RR） was 2.586. [Conclusion] The patients with third trimester adiponectin higher than 7.035ug/mL have 2.586 fold chance to become normal glucose tolerance in 6- 8 weeks after delivery, compared to those whose adiponectin lower than 7.035 ug/mL. It indicates that patients with higher adiponectin concentration in third trimester may have more chance of recovery to normal glucose metabolism.